Central midface fractures should be treated early due to their propensity for secondary devastating and disfiguring consequences. For example, the expected sequelae to inadequately repaired naso-orbital ethmoid (NOE) injuries include shortened retruded nose, altered palpebral fissures, telecanthus, enophthalmos, and ocular dystopia, to name a few. Secondary repair of NOE fractures is indicated when primary surgical repair is not possible and for any of the aforementioned sequelae. When secondary repair of NOE fractures is necessary, these should be planned carefully while focusing on restoring facial function and aesthetics. Specific attention should focus on midface projection and intercanthal relationship. Virtual surgical planning as intraoperative navigation can be helpful for complex secondary reconstructions.